A new program supported by our agency

Take Me Home, West Virginia

Take Me Home provides transition services and support to eligible individuals who are elderly, physically disabled or have serious mental health issues from facility-based living to their own homes and communities.

What is Take Me Home, West Virginia?

Individuals in long-term care facilities face a number of challenges in returning to their homes.  These challenges include lack of money for rental and utility deposits and basic household items, limited community support and limited assistance in transition plan development.

The West Virginia Bureau of Medical Services (BMS) received a Money Follows the Person (MFP) Rebalancing Demonstration Grant in 2011 from the Centers for Medicare and Medicaid Services (CMS) to assist State Medicaid agencies in enhancing opportunities for people to live and receive long-term care services and support in their own homes and communities.

The initiative, Take Me Home, West Virginia, will provide additional services and support to eligible Medicaid members moving from long-term care facilities to their own homes. In addition, the program will explore changes to our State’s long-term care system to enhance home and community-based service options for Medicaid members.

To be eligible to participate in Take Me Home, West Virginia, an individual must:

  • Live in a nursing facility, hospital, institution for mental disease or a combination of any of the three for at least 90 consecutive days (excluding Medicare rehabilitation days) and
  • Receive Medicaid benefits on the last day prior to transitioning from the long-term care facility and
  • Choose to move to a “qualified residence.”

A “qualified residence” is:

  • A person’s own home
  • A person’s family home
  • A person’s own apartment
  • A group home with 4 or fewer people

A full-time Housing Coordinator is available to work with Transition Navigators and participants to identify accessible and affordable housing opportunities.

Take Me Home participants will receive assistance from existing  home and community based services programs such as the Aged and Disabled Waiver, the Traumatic Brain Injury Waiver and Medicaid State Plan Services for which they are eligible.  They may also receive the following grant supported services and support:

  • Transition Navigation: Transition Navigators work one-on-one with participants and/or legal representatives to develop a Transition Plan and facilitate services and support necessary for the person to live in his/her community. They are available to assist participants for one year after the transition.
  • Community Transition Services: These are one-time services essential to facilitate the move home.  These services may include for example: rental and moving deposits, moving expenses and home accessibility modifications.
  • Extended Direct Care Services: Participants may extend the use of certain Medicaid Waiver and State Plan services for which they are eligible.  This may include more direct-care service per month than what is currently available through the Aged and Disabled or Traumatic Brain Injury waiver programs.
  • Take Me Home Goods and Services: These are equipment, services, or supplies not otherwise provided through the Medicaid State Plan that address a need in the Transition Plan, including assistive technology.
  • Supported Housing: Available only to participants transitioning from and Institution for Mental Diseases (IMD), supported housing is independent housing in the community coupled with needed community mental health services.

For more information or to speak to someone directly about the Take Me Home, West Virginia please contact:

Sam Ball

Transitional Navigator for TMHWV